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Rise and falls of dietary antioxidants for disease prevention: Magic bullets, false myth or scarce knowledge?
Abstracts
Metabolic syndrome: When nutrition helps pharma F. Visioli IMDEA-Food, Spain E-mail address: [email protected] The metabolic syndrome requires the presence of central obesity, plus two of the following four additional factors: raised triglycerides, reduced high-density lipoprotein cholesterol, raised blood pressure, or raised fasting plasma glucose level. All of these parameters can be influenced by diet and lifestyle, whose modulation should become integral part of the treatment. Targeted dietary advice should always accompany pharmacological therapy of the metabolic syndrome. While every patient will likely respond differently to adjustments of the dietary regimen, an overall pattern should stress: the use of lowglycemic index carbohydrates, a high proportion of soluble fiber, the preferential use of extra virgin olive oil to dress salads and cooked vegetables, moderate alcohol consumption (within a normo- or hypocaloric diet), an increase in fish consumption possibly accompanied by supplements, and reduced salt consumption. Low compliance to dietary manipulations is often recorded, so frequent interviews and verifications of the patient's attitude toward this nonpharmacological approach are to be integrated in the therapeutic strategy, often making pharmacological treatment unnecessary. doi:10.1016/j.ejphar.2011.09.202
Rise and falls of dietary antioxidants for disease prevention: Magic bullets, false myth or scarce knowledge? M. Serafini INRAN, Italy E-mail address: [email protected] Free radicals, either as a by-product of normal metabolism or associated with inflammatory reactions, can contribute to cardiovascular disease and cancer. Several studies indicate that diets rich in plant foods might reduce oxidative stress-related disease development. Among a number of mechanistic hypotheses, diet-derived antioxidants have been proposed to contribute to explain these findings. However, contrasting results from clinical trials have raised strong concerns about the importance of antioxidants on human health. A vulnerable point of the research on antioxidants is the lack of information on the effect of the whole array of dietary antioxidants in disease prevention, as so far mainly single galenic molecules have been investigated. Despite many food items rich in antioxidants such as chocolate, wine, olive oils, fruit and vegetables have been accredited of an antioxidant action in vivo, the extent to which plant foods are able to tune oxidative stress in human is unclear and it represents a fundamental matter of debate. The first systematic review of dietary intervention studies with plant foods on markers of antioxidant function and oxidative stress will be presented and the association between dietary and endogenous antioxidant defences in vivo will be discussed. The “weight” of variables such as food association and homeostatic control of antioxidant defences will be discussed in order to obtain a realistic portrait of the complex interactions at the basis of the postulated protective effect of antioxidant molecules. There is a strong need of increasing the existing knowledge on the real efficacy of antioxidants in vivo in order to clarify if redox molecules represent a scientific- based strategy for disease prevention or just ancillary ingredients of fruit and vegetables. Keywords: Oxidative stress, Humans, Plant food, Antioxidants doi:10.1016/j.ejphar.2011.09.203
e5
Dose-dependent cholesterol-lowering effects of phytosterol/-stanol-enriched margarine in statin users and non-statin users under free-living conditions S.R.B.M. Eussena,b,⁎, N. de Jongb, C.J.M. Rompelbergb, J. Garssena, W.M. M. Verschurenb, O.H. Klungela a
Utrecht Institute for Pharmaceutical Sciences, Netherlands National Institute for Public Health and the Environment (RIVM), Netherlands E-mail address: [email protected] (S.R.B.M. Eussen)
b
Background: The efficacy (extent to which an intervention produces a beneficial effect under ideal conditions) of the use of phytosterol/-stanol-enriched margarine has been demonstrated in statin users as well as in non-statin users.1 However, inadequate intake levels of the margarines might influence the effectiveness (extent to which an intervention works in daily medical practice) of phytosterol/-stanol consumption. Objectives: The current retrospective cohort study was aimed to assess the effectiveness of the use of phytosterol/-stanol-enriched margarines to lower total and non-HDL cholesterol levels in users and non-users of statins. Methods: Data were obtained from questionnaires on health and food intake from a population-based, longitudinal cohort linked to pharmacy-dispensing records. Multivariate analysis of variance was performed to estimate the effectiveness of enriched margarines and/or statins to lower total and non-HDL cholesterol levels. Results: The analysis included 3829 subjects (31–71 yrs) who were examined during 1998–2002 and re-examined at five-year follow-up during 2003–2007. Recommended doses of margarines were consumed by only 9% of the subjects. Serum non-HDL cholesterol decreased by respectively − 0.18 (95% CI: − 0.29, −0.077), − 1.45 (95% CI: −1.55, −1.35) and − 1.74 (95% CI: − 2.01, −1.46) mmol/l in subjects who started to use phytosterols/-stanols only, statins only or a combination of both compounds at some point in time between examination and re-examination, compared to subjects who did not start using phytosterols/-stanols or statins (see figure). Cholesterol-lowering effects of the phytosterols/-stanols were similar in statin users and non-statin users and increased with increasing intake of enriched margarine (no intake: 0; low intake: −0.017 (95% CI: − 0.16, 0.13); medium intake: −0.089 (95% CI: −0.22, 0.038); high intake: −0.32 (95% CI: −0.50, − 0.14) mmol/l). Conclusions: These data show that although recommended intake levels of the enriched margarines are not reached by all persons, customary use of phytosterols/-stanols is effective in lowering cholesterol levels in both statin users and non-statin users.
Figure. Examination (□, 1998–2002) and re-examination (■, 2003–2007) data of nonHDL cholesterol in non-users, phytosterol/-stanol users, statin users and combination users. ***Change within group, P b 0.001. Different superscripts represent significant difference among groups for change in non-HDL cholesterol (P b 0.05).
Metabolic syndrome: When nutrition helps pharma F. Visioli IMDEA-Food, Spain E-mail address: [email protected] The metabolic syndrome requires the presence of central obesity, plus two of the following four additional factors: raised triglycerides, reduced high-density lipoprotein cholesterol, raised blood pressure, or raised fasting plasma glucose level. All of these parameters can be influenced by diet and lifestyle, whose modulation should become integral part of the treatment. Targeted dietary advice should always accompany pharmacological therapy of the metabolic syndrome. While every patient will likely respond differently to adjustments of the dietary regimen, an overall pattern should stress: the use of lowglycemic index carbohydrates, a high proportion of soluble fiber, the preferential use of extra virgin olive oil to dress salads and cooked vegetables, moderate alcohol consumption (within a normo- or hypocaloric diet), an increase in fish consumption possibly accompanied by supplements, and reduced salt consumption. Low compliance to dietary manipulations is often recorded, so frequent interviews and verifications of the patient's attitude toward this nonpharmacological approach are to be integrated in the therapeutic strategy, often making pharmacological treatment unnecessary. doi:10.1016/j.ejphar.2011.09.202
Rise and falls of dietary antioxidants for disease prevention: Magic bullets, false myth or scarce knowledge? M. Serafini INRAN, Italy E-mail address: [email protected] Free radicals, either as a by-product of normal metabolism or associated with inflammatory reactions, can contribute to cardiovascular disease and cancer. Several studies indicate that diets rich in plant foods might reduce oxidative stress-related disease development. Among a number of mechanistic hypotheses, diet-derived antioxidants have been proposed to contribute to explain these findings. However, contrasting results from clinical trials have raised strong concerns about the importance of antioxidants on human health. A vulnerable point of the research on antioxidants is the lack of information on the effect of the whole array of dietary antioxidants in disease prevention, as so far mainly single galenic molecules have been investigated. Despite many food items rich in antioxidants such as chocolate, wine, olive oils, fruit and vegetables have been accredited of an antioxidant action in vivo, the extent to which plant foods are able to tune oxidative stress in human is unclear and it represents a fundamental matter of debate. The first systematic review of dietary intervention studies with plant foods on markers of antioxidant function and oxidative stress will be presented and the association between dietary and endogenous antioxidant defences in vivo will be discussed. The “weight” of variables such as food association and homeostatic control of antioxidant defences will be discussed in order to obtain a realistic portrait of the complex interactions at the basis of the postulated protective effect of antioxidant molecules. There is a strong need of increasing the existing knowledge on the real efficacy of antioxidants in vivo in order to clarify if redox molecules represent a scientific- based strategy for disease prevention or just ancillary ingredients of fruit and vegetables. Keywords: Oxidative stress, Humans, Plant food, Antioxidants doi:10.1016/j.ejphar.2011.09.203
e5
Dose-dependent cholesterol-lowering effects of phytosterol/-stanol-enriched margarine in statin users and non-statin users under free-living conditions S.R.B.M. Eussena,b,⁎, N. de Jongb, C.J.M. Rompelbergb, J. Garssena, W.M. M. Verschurenb, O.H. Klungela a
Utrecht Institute for Pharmaceutical Sciences, Netherlands National Institute for Public Health and the Environment (RIVM), Netherlands E-mail address: [email protected] (S.R.B.M. Eussen)
b
Background: The efficacy (extent to which an intervention produces a beneficial effect under ideal conditions) of the use of phytosterol/-stanol-enriched margarine has been demonstrated in statin users as well as in non-statin users.1 However, inadequate intake levels of the margarines might influence the effectiveness (extent to which an intervention works in daily medical practice) of phytosterol/-stanol consumption. Objectives: The current retrospective cohort study was aimed to assess the effectiveness of the use of phytosterol/-stanol-enriched margarines to lower total and non-HDL cholesterol levels in users and non-users of statins. Methods: Data were obtained from questionnaires on health and food intake from a population-based, longitudinal cohort linked to pharmacy-dispensing records. Multivariate analysis of variance was performed to estimate the effectiveness of enriched margarines and/or statins to lower total and non-HDL cholesterol levels. Results: The analysis included 3829 subjects (31–71 yrs) who were examined during 1998–2002 and re-examined at five-year follow-up during 2003–2007. Recommended doses of margarines were consumed by only 9% of the subjects. Serum non-HDL cholesterol decreased by respectively − 0.18 (95% CI: − 0.29, −0.077), − 1.45 (95% CI: −1.55, −1.35) and − 1.74 (95% CI: − 2.01, −1.46) mmol/l in subjects who started to use phytosterols/-stanols only, statins only or a combination of both compounds at some point in time between examination and re-examination, compared to subjects who did not start using phytosterols/-stanols or statins (see figure). Cholesterol-lowering effects of the phytosterols/-stanols were similar in statin users and non-statin users and increased with increasing intake of enriched margarine (no intake: 0; low intake: −0.017 (95% CI: − 0.16, 0.13); medium intake: −0.089 (95% CI: −0.22, 0.038); high intake: −0.32 (95% CI: −0.50, − 0.14) mmol/l). Conclusions: These data show that although recommended intake levels of the enriched margarines are not reached by all persons, customary use of phytosterols/-stanols is effective in lowering cholesterol levels in both statin users and non-statin users.
Figure. Examination (□, 1998–2002) and re-examination (■, 2003–2007) data of nonHDL cholesterol in non-users, phytosterol/-stanol users, statin users and combination users. ***Change within group, P b 0.001. Different superscripts represent significant difference among groups for change in non-HDL cholesterol (P b 0.05).